Progress towards health inequalities targets

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

Abstract

The Government set health inequalities targets in 2003, to be met by 2010, around infant mortality rates and life expectancy figures. The purpose of these targets is to narrow the differences in 'health' levels between the poorest socio-economic classes and the poorest performing regions of the country, as compared to population averages. This report provides an update on progress towards those targets, and shows that progress towards meeting these targets is not being met.

Recent developments

Specifically, the targets are to reduce inequalities in health outcomes, as measured by infant mortality and life expectancy at birth, by 10% by 2010 between those with the poorest health and population averages. The Government had implemented a wide range of social and economic policy, much of which had actually been introduced before the targets were developed, which it hoped would help towards reducing health inequalities. Reducing health inequalities was not the primary purpose of introducing many of these policies, but nonetheless the Government hoped that a reduction in health inequalities would be one of their outcomes. The policies included the introduction of a national minimum wage, a 'New Deal' to reduce long term unemployment, a 'Strategy for Neighbourhood Renewal', and a cross-cutting spending review across the various Government departments to assess whether Government resources were being spent to the best capacity.

The most recent policy innovation, however, has been the creation of what are termed 'spearhead'  local authorities. These are local authorities that have the worst health indicators among their populations, and in total cover 28% of the population of England.  It is on these spearhead local authorities that the Government's focus has been targetted, and they have recently introduced what is known as a 'health inequalities intervention' tool. This tool is a web-based instrument that allows each spearhead local authority to assess how well it is doing against other spearhead authorities on various indicators of health. Presumably, therefore, the Government hopes that this will serve as a form of non-financial incentive system, spurring each authority to improve its performance against its closest competitors.

On the basis of empirical evidence of other attempts to use such 'league table' competition to improve performance, this is not a bad idea. For example, the Veterans Health Administration in the United States has improved various process quality indicators through similar means, and the UK NHS was seemingly achieving some success around reducing hospital waiting times and ambulance response rates when using this type of mechanism in the star rating system. In terms of health inequalities, it appears that the Government's logic is that if the authorities with the worst population health levels can be encouraged to compete against each other to improve the health of their populations, then collectively they will close the gap on the population average for the country as a whole.  

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral
current    previous

Personally, given that the health for all groups is obviously improving in terms of these broad health indicators, and given that the infant mortality rates and life expectancy figures for all groups are pretty good, the focus on reducing health outcomes inequalities seems somewhat misguided to me. Intellectual and financial resources could now probably be focused on objectives that would more usefully improve societal welfare, although, as noted earlier, the health inequalities intervention tool, with it's embedded incentives to stimulate competition among the spearhead local authorities to improve a variety of health indicators among their local populations, may, in time, produce interesting results.

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Initiators of idea/main actors

• Government

• Parliament

• Opinion Leaders

Stakeholder positions

The stakeholder positions are pretty much the same as they were in the previous report. The Central Government is clearly supportive, because they're their targets, and the Strategy Unit in the Department of Health are currently trying to develop new ways to tackle health inequalities. The direction will remain part of policy for the foreseeable future, unless there is a change of Government. The public health community is generally supportive of reducing health inequalities. Some local government managers might be a bit frustrated, because no matter how much they improve their own population's health, health inequalities will widen if other local governments improve their populations' health more.  

Actors and positions

Government
Central Government	very supportive		strongly opposed
Local Government	very supportive		strongly opposed
Parliament
Labour Party	very supportive		strongly opposed
Conservative Party	very supportive		strongly opposed
Opinion Leaders
Public health community	very supportive		strongly opposed
current    previous

Influences in policy making and legislation

Not applicable - the targets are part of policy.

Legislative outcome

n/a

Actors and influence

Government
Central Government	very strong		none
Local Government	very strong		none
Parliament
Labour Party	very strong		none
Conservative Party	very strong		none
Opinion Leaders
Public health community	very strong		none
current    previous

Positions and Influences at a glance

Adoption and implementation

The only significant new developments at this time are the categorisation of the spearhead local authorities and the health inequalities intervention tool, described earlier. As noted above, the Strategy Unit in the Department of Health are currently devising new health inequalities policy, which may involve targetting financial incentives towards the poor to encourage them to improve their health-related behaviours, but this policy direction has not been decided upon yet and therefore a description of it will have to wait for future reports.  

Monitoring and evaluation

Between 1999 and 2006, the health of all groups improved, but the health of the lower socio-economic classes improved at a slower rate than the rest of the population, and therefore health inequalities continued to widen. For example, the infant mortality rate for the manual classes fell from 6.3 to 5.6 per 1,000 live births. The population average fell from 5.6 to 4.8 per 1,000 live births. Therefore the infant mortality rate was higher than the population average by 13% in 1999 and 17% in 2006.

In terms of life expectancy, the gap has also widened. For example, for men, the 'spearhead' local authority life expectancy was 72.7 years and the population average was 74.6 years in 1997. In 2006, the figures were 75.3 years and 77.3 years, respectively. The difference had therefore increased from 2.57% higher to 2.63% higher. For women, the difference increased from 1.77% higher to 1.96% higher over the same period.

Expected outcome

Everybody's health is improving, but as noted above, the health of the lowest socio-economic classes is improving at a slower rate than the population average. This has been the historical trend for at least the last 50 years. I would be very surprised if the Government's health inequalities targets are met by 2010, but no doubt that will place great symbolic value on them if they do manage to meet them.

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high
current    previous

References

Sources of Information

Department of Health. Tackling health inequalities: 2004-06 data and policy update for the 2010 national target. Department of Health: London, 2007. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081327

House of Commons, Health Committee. Health Inequalitites. Volume II. Ordered by The House of Commons to be printed 13 March 2008. www.publications.parliament.uk/pa/cm200708/cmselect/cmhealth/422/422ii.pdf.

 

Reform formerly reported in

Health Inequalities Targets Process Stages: Implementation

Author/s and/or contributors to this survey

Adam Oliver

Suggested citation for this online article

Adam Oliver. "Progress towards health inequalities targets". Health Policy Monitor, April 2008. Available at http://www.hpm.org/survey/uk/a11/5